PCSS-B Mentors and Participants The PCSS-B currently has 88 physician-mentors and five clinical experts located in 61 cities across 34 states and Puerto Rico. Nearly all mentors are certified in the treatment of addictions (81%) and had more than three years of experience treating opioid dependence when they joined the PCSS-B (93%). Mentor specialties include psychiatry (40%), internal medicine (24%), family medicine (15%), and addiction medicine (14%). Half identified their primary practice setting as an addiction treatment program, 25% a private practice and 22% an academic institution.As of July 2009, a total of 4,162 individuals have registered into the PCSS-B system representing all 50 states, Washington DC, and Puerto Rico (Fig. ). PCSS-B participants identify their specialty as psychiatry (36%), internal medicine (13%), family medicine (22%), addiction medicine (3%), and other (24%). Primary practice settings include private practice (49%), academic setting (8%), addiction treatment programs (5%), and other (35%). The majority of individuals (76%) self-registered by phone or through the website or were automatically registered at a training designed to allow physicians to meet the requirements of DATA 2000. Far fewer (5%) were registered into the system by a mentor. Mentor-registered participants, however, account for over half of the mentor contacts recorded.
PCSS-B registered participants, contacts, and methadone treatment availability.
PCSS-B Services Provided (mentor-participant contacts) Between July 2005 and July 2009, 67 mentors and four clinical experts reported providing mentoring services to 632 participants in 48 states (none in Iowa or Utah), Washington DC and Puerto Rico (Fig. ). A total of 1,455 contacts were provided through email (45%), telephone (34%) and in-person visits (20%). Mentors provided a wide range of services and support. Seventy six percent of contacts included a clinical issue and 18% included a logistical issue. The most frequently requested clinical and logistical support is presented in Table . The number of contacts per participant varied greatly, ranging from 1 to 125. The majority of participants had five or fewer contacts. Mentors report spending an average of 5 minutes on preparation, 15 minutes of direct contact, and about 3 minutes on follow per contact.
Most Frequently Provided Clinical and Logistical Support
Warmline The PCSS-B warmline responds to an average of 100 inquiries and requests each month via email (55% of inquires), phone (43%), the website and fax (both < 1%). Overall, just under half of the requests (49%) were from individuals seeking a mentor and about a third (31%) were requests for general information about the PCSS-B. Other requests included information about buprenorphine courses/trainings (7%), continuing medical education (5%), the buprenorphine physician locator (4%), and how to become a mentor (3%).
PCSS Clinical Guidances and Website Use Mentors reported distributing PCSS-B clinical guidances in over 10% of contacts. Between August 2005 and April 2009 there were 72,822 visits to the PCSS-B website with 179,678 pages viewed. The pages most often viewed were those that included information on the PCSS-B, the mentors, or resources related to buprenorphine prescribing and seven guidances were downloaded more than 1,000 times (Table ).
Most Frequently Downloaded PCSS-B Website Documents
Outreach to Primary Care From 2005–2008, mentors presented 57 educational workshops to state chapters of American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and state medical societies including a number of states in which access to opioid treatment is less readily available such as Alaska, Hawaii and North Dakota. Articles about the PCSS-B have appeared in over 35 different publications, including USA Today, American Medical News, American Academy of Family Practice News Now and Society of General Internal Medicine Forum, as well as 14 State Medical Association newsletters.
Support for Opioid Treatment in Areas with Limited Availability of These Services
Geographic data suggest that the PCSS-B has been successful at providing support for the treatment of opioid addiction to areas with little or no access to methadone. In some parts of the United States, buprenorphine offers the first and only access for pharmacologically-based treatment for opioid dependence. A goal of the PCSS-B was to promote the availability of buprenorphine across the country paying particular attention to those areas without reliable access to methadone treatment. The program has proven successful at providing support to physicians in several remote areas and in states that do not permit methadone maintenance treatment or have greatly limited access to methadone maintenance treatment for opioid dependence. This can be seen in the map (Fig. ) which plots the locations of PCSS-B contacts and the availability of methadone treatment.35
In the 13 states with fewer than five locations to access methadone treatment (AK, AR, DE, HI, IA, ID, MS, MT, ND, NE, SD, TN, WY), mentors have had 100 contacts with PCSS-B participants. Additionally there is evidence to support the role of PCSS-B in providing support to providers in rural areas which lack methadone treatment opportunities.